Outbreak of avian flu has killed more than 100 million birds and poses a serious threat of becoming a human pandemic

The COVID-19 pandemic, which has claimed the lives of more than 21 million people, has raised an existential question into concrete immediacy. After COVID-19, when will the next deadly pandemic strike again?

A chicken farm [Photo by Fot. Konrad Łoziński / CC BY 2.0]

The first major global monkeypox outbreak affected multiple countries on almost every continent. It felt like the world dodged a bullet as the cases subsided. The outbreak of the extremely deadly Ebola Sudan virus in Uganda also threatened the region and beyond as it spread to the densely populated capital Kampala. Such potential crises have occurred much more frequently in recent years and make new pandemics a non-negligible risk for the world population.

The first new post-COVID-19 pandemic, still infecting billions of people, may already be on the horizon, but is largely overlooked or dismissed by most news outlets and not receiving political attention.

The largest recorded outbreak of highly pathogenic avian influenza (HPAI) has killed millions of birds since October 2021. Overall, more than 140 million poultry, including 60 million in North America and 48 million in Europe, have died from disease and related culling, according to the World Organization for Animal Health (WOAH).

A genetic analysis of the H5N1 influenza virus in the current avian pandemic has localized it to a clade (virus family) that circulates among poultry and wild birds on several continents, but is most closely related to strains among European seabirds.

The first cases in North America were detected at a bird farm in Newfoundland and Labrador, Canada, in December 2021. In February 2022, Florida’s Fish and Wildlife Conservation Commission reported that the deaths of black vultures at the state’s Hontoon Island State Park were caused by the same virus.

Over the next few months, the virus had spread to numerous species of wild birds, commercial poultry, as well as mammals including grizzly bears, red foxes, coyotes, seals and dolphins, as well as a human case confirmed April 27 by the U.S. Centers for Disease Control and Prevention (CDC) on a Colorado prisoner involved in the culling of infected poultry.

In February 2022, The Wall Street Journal found that bird flu had struck a chicken farm in Fulton, Kentucky and a Tyson Foods chicken farm house, raising concerns about a repeat of the last major bird flu disaster in 2015.

Egg prices are up almost 60 percent year-on-year through December, with egg stocks down 29 percent. Nebraska currently has 6.7 million poultry deaths, up from 4.8 million during the 2015 outbreak. Colorado has lost 90 percent of its layers, according to the Journal.

As devastating as the outbreak was for the bird population, fears remain that the virus will learn to efficiently use a human host to transmit itself. To date, according to the World Health Organization (WHO), there have been only 864 human cases of H5N1 between 2003 and March 2022 in 18 countries worldwide. The infection in the USA was the first time for this country.

But the death rate is dangerously high, with 456 deaths among the 864 cases, a 53 percent chance of dying if infected. So far, cases have remained sporadic in small clusters, involving contact with infected poultry or contaminated environments.

However, there is growing concern among scientists that a more virulent infectious form of the virus could suddenly evolve and spread rapidly through the human population as a deadly airborne pathogen. Wend Blay Puryear, a molecular virologist at Tufts University, told the Guardian: “There is concern that it has pandemic potential. Before COVID was on anyone’s radar, this was the one we were all watching closely.”

A recent report in Think Global Health states: “Every time one species transmits the virus to another, it constitutes a spillover event. These myriad transmission effects – among wild bird species, from wild birds to domestic birds, from birds to mammals and from animals to humans – raise serious concerns about the potential for further adaptation and evolution of this influenza lineage and the continued risk associated with bird migration. Understanding which species among these many hosts might help the virus adapt is critical for targeted surveillance and mitigation efforts.”

The last pandemic to cause such devastation among birds began in December 2014, when more than 50 million birds died, costing farmers over $1.6 billion. But in the summer of 2015, the virus suddenly disappeared as quickly as it had appeared. Migratory birds returning to Canada were found to be virus-free.

In the present case, however, the outbreak lasted throughout the summer and increased sharply again this winter. Active surveillance has identified more than 3,300 infected birds in 100 species, an immense level of transmission compared to the outbreak in 2014-2015, when fewer than 100 wild birds tested positive for H5N1.

A Colorado Department of Agriculture veterinarian, Maggie Baldwin, told the Journal: “One of the challenges is that we don’t know why [the virus] could thrive for so long. We are almost a full year into this outbreak and it is still ongoing.”

Mike Tincher, rehabilitation coordinator for the Rocky Mountain Raptor Program in Colorado, said, “There is no historical context for this. It’s like when COVID hit people… We’ve never seen it before. And it just doesn’t slow down.”

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As the US Department of Agriculture recently noted, “Wild birds can be infected with HPAI and show no signs of disease. They can carry the disease when migrating to new areas and potentially exposing domesticated poultry to the virus.” Such asymptomatic spread of the virus poses an extraordinary challenge for the international community unless surveillance systems in the animal and human sectors are strengthened.

A recent Eurosurveillance report has attracted a lot of attention on social media. It details the outbreak of HPAI H5N1 among intensively farmed mink in the Galicia region of north-west Spain in October 2022. Aris Katzourakis, Professor of Evolution and Genomics at the University of Oxford, tweeted: “[I] do not understand how mink farming can be defended. Viruses move easily between mink and humans, and this could play a big role in the origin of future pandemics.”

When the first outbreak emerged, veterinarians had assumed the disease was caused by SARS-CoV-2, as it had previously infested mink farms in Denmark in November 2020. However, laboratory tests revealed that HPAI H5N1 was the culprit. More than 52,000 mink on the farm had to be culled.

As the Eurosurveillance report noted, the mink were kept in open barns and fed raw fish and poultry by-products from the same region. Their detailed analysis revealed that the virus is similar to the virus circulating among birds on several continents.

A Sciencearticle published this week on the outbreak of avian influenza at Spain’s mink farm stated: “The virus is not known to spread well between mammals; Humans almost always get it from infected birds, not from each other. But now, H5N1 appears to have spread through a densely packed mammal population and acquired at least one mutation that favors mammal-to-mammal spread. Virologists warn that H5N1, now rampaging through birds around the world, could spread to other mink farms and become even more transmissible.”

Tom Peacock, a virologist at Imperial College of London, warned: “This is incredibly worrying. This is a clear mechanism for the onset of an H5 pandemic.”

The mutation in question is unusual and has only been observed once in a European polecat, according to CIDRAP. The mutation may have evolved spontaneously among mink in a convergent evolutionary pathway. The new variant, designated 2.3.4.4b, emerged in Europe in late 2020 and became prevalent in wild birds. It is believed to have originated in Korea through a process of rearrangement between the H5N1 and clade 2.3.4.4b H5N8.

Although it appears the mutation may be less pathogenic to humans, about six people have contracted the virus so far and one has died. It also appears to be better adapted to all birds, as noted by Richard Webby, an influenza researcher. It is worrying that this resurgence of H5N1 has infected numerous species of mammals.

Thomas Mettenleiter, head of the Friedrich Loeffler Institute, explained in an interview with Science about the lower pathogenicity (lethality) of the new strain in humans: “Of course, this can also be bad news because it may be easier for the virus to start spread under the radar and give it more opportunity to evolve.”

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